9/11 Jack pmps 107, +2/93, +3/81 +4/81 +5/74 +5.5 79 +6/76

Hello All,

Based upon the TR protocol .5u for 151 -170. Since Jack was 155 I gave the .5u.

My questions are:

If his PS is <151 should I skip or opt for a skinny .5 ?

Assuming I skip, I might see a higher number at +4, +5 (due to feeding) and an acceptable number @ +4, +5 would be? Then moving forward to the next PS how should I handle it. Adhere to the protocol numbers regardless?

In a nutshell, at what point would I skip lets say a whole day ?

Today I am starting to break his 2 meals a day into 4. I read that it is easier on the pancreas.

I normally feed @ 6 AM and then @ +4, +5 for nadir testing.

Any thoughts on changes that might occur with the timing/results of the nadir testing ? Should I not feed within 2 hours before the test for example? Or should I wait to feed after the +4 and +5 ?

I am thinking that a curve might look a little jagged towards the bottom with changing the timing of the feeding. Quantity will be the same 1/2 can Purina DM wet bid. Just split into 2 servings.

Thank you in advance.

Re: Jack - AMPS 155 Gave .5 - Dosaage vs. Numbers questions

Hi! This is the first time I've been to your condo!

What do you mean "the protocol numbers?"

Lantus works best with consistency, and after looking at Jack's spreadsheet, it looks like you're bouncing around in dosages too often. Lantus builds a depot in the body, so if the dosage is adjusted too often the depot fills and the depot drains.

The Lantus dose is also based on the nadir, not the preshot number. On 9/9 Jack got a nadir of 74 on the .5u. That looks like it's a good dose for now. By giving him .25u last night, Jack's depot drained a little bit, so you'll likely see higher numbers than you would have, had you stuck to the .5u.

The protocol calls for holding the starting dose for 5-7 days before making any adjustments and then changing the dose by .25 units every 6 cycles (3 days) after that, depending on the nadir.

Looking at the top of your spreadsheet, in my opinion, your vet had you giving Jack way too much insulin too quickly. They were raising it in 1 unit increments, which is A LOT for a cat. Those high numbers (like the 434 on 8/28) is most likely a bounce from Jack's BG going too low and his body producing glucose as a lifesaving mechanism to prevent a hypoglycemic event.

Personally, I'd hold the .5u for the next few days, get good mid-cycle tests (which you're doing even at night, great job!) and then re-evaluate the dose if the nadirs aren't where they should be.

~Suzanne

Re: Jack - AMPS 155 Gave .5 - Dosaage vs. Numbers questions

Hi Suzanne,

Thank you for the reply.

His dosage changes initially were caused by me calling the vet with the numbers. And I did not feel they were coming down as fast as of course, I wanted them too.

The Lantus dose is also based on the nadir, not the preshot number. On 9/9 Jack got a nadir of 74 on the .5u. That looks like it's a good dose for now. By giving him .25u last night, Jack's depot drained a little bit, so you'll likely see higher numbers than you would have, had you stuck to the .5u.

Click to expand...

I understand about the nadir but at what PS value would I not give a shot? Vet said 70 but then again, it is 1u if between 70 and 100. So I cannot and do not rely completely on what the vet says. I do want to maintain consistency as I realize now how important it is.

In the example of 9/9, His PS was 134 and with .5 he got to the 70's and that I have heard is good and I would continue the .5u so long as his PS was hanging right around 134.

Lets say that I got a PS the next day of 100. My rational would be if @134 and .5u got him into the 70's, that a starting PS of 100 and .5u would drive him too low.. Am I correct? In the neighborhood? or Left Field?

Any input would be greatly appreciated.
Kevin


I got the protocol information at www.yourdiabeticcat.com (see below). The following is a suggested “sliding scale” for the cat just starting Tight Regulation. The protocol asks the owner to test at least twice daily, but optimally three or four times daily (every 6-8 hours), with doses of insulin given according to the reading at each test:


Blood Glucose mg/dl Units of Insulin to Inject
151-170 .5
171-185 1
186-200 1.5
201-220 2
221-250 2.5
251-290 3
291-350 3.5
351-410 4

Using this protocol, you can expect to start seeing some very “normal” numbers within a few days or weeks of starting. As long as you are feeding your cat ONLY low-carbohydrate foods, you do not need to be fearful of clinical hypoglycemia. In fact, those blood glucose numbers in the 60-120 range are the objective of the protocol. Even if the blood glucose drops to 30-50, do not feed sugar syrup or dry food. A small, high protein wet food meal is all you need for a cat at these numbers and that is more for the owner than the cat. As time passes, smaller doses will achieve the same results that larger ones once did, and you will even start skipping doses as you test and find the blood glucose is still in the normal range many hours or even days after the last dose of insulin. When this happens, you will know your cat’s own pancreas is beginning to function on its own. For more information on this method, see www.yourdiabeticcat.com.

I know I have to check the nadir and if it is putting him too low, I need to adjust.

Since I am a AlphaTrak user, I figure if I get 70's at nadir, that the dose is good. right?

Re: Jack - AMPS 155 Gave .5 - Dosaage vs. Numbers questions

Hi Kevin!

Thebudster77 said:

His dosage changes initially were caused by me calling the vet with the numbers. And I did not feel they were coming down as fast as of course, I wanted them too.

Click to expand...

Trust me, we've all been there! The vet that initially diagnosed Cobb took him up 1 unit at a time, sometimes 2units at a time. We weren't seeing any results. I mean, his numbers were stuck at 500+. She told me it was fine to keep him on dry food, etc. Bless her heart, she didn't know what she was talking about. Most of us don't provide our vets with the curve numbers because they really aren't well versed in feline diabetes. Whereas the people here live it and care for their diabetic animals all the time. I think of it like a general practitioner. They know a little about a lot, but if you have a heart problem, you're going to see a cardiologist who knows the diseases and the organ inside out, right?

Thebudster77 said:

I understand about the nadir but at what PS value would I not give a shot? Vet said 70 but then again, it is 1u if between 70 and 100. So I cannot and do not rely completely on what the vet says. I do want to maintain consistency as I realize now how important it is.

Click to expand...

So...this is a situation where every cat is different, and where you really have to "know thy cat." You're using an AlphaTrak2, correct? Most of us use human glucometers. The strips are a LOT cheaper and they're just as reliable. I, for instance, use the Relion Confirm from Walmart. So on a human meter, I will shoot pretty much anything over 55, although I'm more comfortable shooting over 60. I always hold my breath if it is between 50 and 60. Those values are LOW on an AlphaTrak though. BJM has an excellent chart that she shares with new members. You can find it here: https://docs.google.com/document/d/1oI_ ... QD2JU/edit. You'll see the 50 - 130 mg/dL is more like 71-83 to 186-217 mg/dL for an AlphaTrak. I equate a 50 to a 70 on an AT.

So what is your no shoot number? As frustrating as this answer is, it depends on your cat and how he reacts to the insulin and when the onset is. (I realize that isn't the answer you are looking for.) For newbies, we recommend they don't shoot under 200 (286-333 mg/dL for an AlphaTrak) without posting here first. HOWEVER, you are already shooting under that number so you need to decide what number you are comfortable shooting a full dose at. Again, for me it is around 60, but I know how Cobb historically reacts when I shoot him that low. Sometimes I chicken out. Most of the time I don't now. You want to have enough data in your spreadsheet that you can refer back to and say, "OK. I shot Jack with 1u when he was at 135 and he dropped 50 points. It's probably safe to shoot a full dose at 135 again. But if I shoot him at 100 he historically goes too low so I'll have to either stall or skip if that happens." Does that make sense?

Thebudster77 said:

Lets say that I got a PS the next day of 100. My rational would be if @134 and .5u got him into the 70's, that a starting PS of 100 and .5u would drive him too low.. Am I correct? In the neighborhood? or Left Field?

Click to expand...

That does sound logical, doesn't it? Unfortunately, it doesn't necessarily happen that way. Look at 9/4 and 9/5 on Jack's spreadsheet. You gave 1u the morning of 9/4, the evening of 9/4 and the morning of 9/5. You see how in the morning cycle that 1u brought him down about 10? The 185 and 171 aren't really all that different in readings. We call that "surfing." That evening you gave him 1u with a 158 reading and he came down to, at least, 101 -- maybe lower in that cycle. Here's why I say he probably went lower. The morning of 9/5 he was at 220 and you shot 1u and he jumped up over 400. We call that bouncing. His body isn't used to regular numbers and perceived the drop to near 100 as a hypo event (even though we know differently). It is likely he went below 100 and his body panicked. But you see how the same dose can give you different results?

Cobb is a high dose cat, but you can see how he can fluctuate day by day on the same dose.

Thebudster77 said:

I got the protocol information at http://www.yourdiabeticcat.com (see below). The following is a suggested “sliding scale” for the cat just starting Tight Regulation. The protocol asks the owner to test at least twice daily, but optimally three or four times daily (every 6-8 hours), with doses of insulin given according to the reading at each test:


Blood Glucose mg/dl Units of Insulin to Inject
151-170 .5
171-185 1
186-200 1.5
201-220 2
221-250 2.5
251-290 3
291-350 3.5
351-410 4

Using this protocol, you can expect to start seeing some very “normal” numbers within a few days or weeks of starting. As long as you are feeding your cat ONLY low-carbohydrate foods, you do not need to be fearful of clinical hypoglycemia. In fact, those blood glucose numbers in the 60-120 range are the objective of the protocol. Even if the blood glucose drops to 30-50, do not feed sugar syrup or dry food. A small, high protein wet food meal is all you need for a cat at these numbers and that is more for the owner than the cat. As time passes, smaller doses will achieve the same results that larger ones once did, and you will even start skipping doses as you test and find the blood glucose is still in the normal range many hours or even days after the last dose of insulin. When this happens, you will know your cat’s own pancreas is beginning to function on its own. For more information on this method, see http://www.yourdiabeticcat.com.

I know I have to check the nadir and if it is putting him too low, I need to adjust.

Click to expand...

I see where you got your protocol from. We don't use a sliding scale for Lantus on FDMB. This is the protocol we use: viewtopic.php?f=9&t=1581. Since I'm not familiar with the one on yourdiabeticcat.com, I can't really speak to it. I would guess others here have seen it before and may be able to speak to it. I know we have had great success with the protocol that we use. It has been published in the Journal of Feline Medicine and Surgery. We've had hundreds of cats follow it and gone OTJ (off the juice) and they are now food controlled diabetics. Whichever protocol you want to use is up to you, but the people here are very familiar with the protocol I posted and advise based on it.

Thebudster77 said:

Since I am a AlphaTrak user, I figure if I get 70's at nadir, that the dose is good. right?

Click to expand...

Nadirs in the 70s on AT are good, maybe a little low. 70 would be ideal on a human meter. Just curious...is there a reason you want to stick with the AT? It's purely personal preference. But the strips can run upwards of $1 each. I can get 100 strips for my Confirm meter for $35 at Walmart, and you can order them in bulk from American Diabetes Wholesale online.

Definitely ask lots of questions. We can get you set up on the protocol we use. I think it is easier to not shoot on a sliding scale, and Lantus really doesn't do well on a sliding scale, from what I've observed here.

~Suzanne

Re: Jack - AMPS 155 Gave .5 - Dosaage vs. Numbers questions

It is best if you continue to give .5U morning and night for the next few days, regardless of preshot - unless Jack gets a nadir below 68 on your Alphatrak. We can't determine how this dose is doing, until you have 6 cycles in a row of the same dose. Lantus works best if you give the same amount of insulin each shot. It is a depot type of insulin. The older insulins and PZI/Prozinc are dosed based on preshot values, and many vets were schooled in those types of insulins. Lantus (and Levemir) work differently. We dose base on the nadir value. As long as Jack is getting some green nadirs (above 68), the .5U is still a good dose.

That 68 is our "take action" number on the Alphatrak (50 on a human glucometer) which means he's earned a reduction. Our protocol uses numbers on the human glucometers, because that's what most of us have.

We do shoot low to stay low here. When you give insulin at a lower preshot, the entire cycle is often flatter. However, some people feel nervous shooting low the first times, and it's safer to do so when you have some data on what Jack's cycles look like. On this forum, if people get a number below 150 before for the first time, we ask that they post with the number and ask for help. There are several ways to handle low numbers, which are documented in our Shooting and Handling Low Numbers Sticky Note.

If you look at the Tight Regulation Protocol we use here, there is a document 5 paragraphs down, called Management of Diabetic Cats. That is a paper describing the original research the protocol is based on. You may wish to print that off and share it with your vet.

Re: Jack - AMPS 155 Gave .5 - Dosaage vs. Numbers questions

A comment on the other website's protocol and this statement:

Even if the blood glucose drops to 30-50, do not feed sugar syrup or dry food. A small, high protein wet food meal is all you need for a cat at these numbers and that is more for the owner than the cat.

Click to expand...

Here we do not follow that statement. We do not feed dry food, but our hypo kit recommends having some high carb wet food available for those times when the cat goes below 50. An alternative to high carb food is putting a drop or two of karo on regular wet food. Some kitties only need medium carb food or a higher lower carb food to lift their numbers, but it depends on the cat. Some are not very carb sensitive and need the extra carbs. It's best to start with high carb food until you learn how carb sensitive Jack is.

Review and print off the Handling Low Numbers sticky note I referred to above. It's good to have in case there is a power outage or you can't get on the board for help. We've seldom seen cats go hypoglycemic and mostly because the vet started them on too high a dose, but that's because we intervene when kitties blood sugar goes too low. You risk brain damage and worse if kitty gets too low.

Re: Jack - AMPS 155 Gave .5 - Dosaage vs. Numbers questions

Kevin --

Please, please, please do not use the protocol on the Your Diabetic Cat site. They basically took a PZI protocol and are using it with Lantus. They are very different types of insulin and what works for one doesn't really work for the other. There have been problems with their protocol especially due to the quote that Wendy provided. They have had cats experience symptomatic hypoglycemic episodes with permanent damage as a result. The methods they are using are not based on any published research. The Tight Regulation Protocol we use here is based on research that was published in one of the top feline veterinary journals. We know that the protocol is safe.

As far as what is a safe number to shoot, many of us will shoot anything above 50. If you have strips, high carb food, and are going to be home to monitor, you can shoot low numbers. The trickier part is getting comfortable with shooting low. Most people work their way down -- initially shooting above 150, then 100, and then shooting green numbers. In the process, you will be gathering data and learning more about how Jack is responding.

Re: Jack - AMPS 155 Gave .5 - Dosaage vs. Numbers questions

I have a distinct bias towards the protocol we follow here - it has a proven track record - we have 299 kitties since 2008 that have gone off of insulin following this protocol. The last few months we've sometimes had 3 or 4 per month go off. So because I've seen its success, I know it works.

It's also safe. The only cats i've seen hypo on Lantus/Lev were kitties that arrived here overdosed coming from elsewhere. People who learn how to test, who stick around long enough to under the protocol dosing adjustments and how to "read" their cat's spreadsheet keep their cats safe.

It's the only protocol published in a professional veterinary journal.

My concern about the one you've printed is that it doesn't jive with how we know Lantus works. The older insulins that were not long-lasting (ie, didn't have a depot) were dosed based upon the preshot. You learned how far your cat would drop from various preshot numbers and then you adjusted the dose based upon that number.

The newer insulins, Lantus and Levemir, work differently. Here is a link that tells you about how the insulin depot works. The first link there tells the difference between Lantus and Lev, but in doing so, you'll see how Lantus works. That's pretty important.

Understanding the depot/slow release concept makes it easier to understand why we don't change doses based upon the preshot. We test to learn how LOW a dose takes a cat. Then we adjust the dose every 3 or so days based upon the average number of low points in the previous 3 or so days.

For that AT, normal numbers are 68-160ish, approximately. The burden will be upon you to continually remind us that you're using an AT. Since they are so expensive, few people use them. When you read the protocol guidelines, you'll want to make the mental translation to AT numbers.

The 68-160ish AT is equivalent to 50-120 human meter. That's the range you're aiming for with Jack.

Since you've already shot plenty of times into normal numbers, which is what we consider shooting low, you can probably keep doing it. One thing to remember is that anytime you shoot a number lower than you've shot before, you want to get a +1 and a +2 to know where Jack's headed next in the cycle.

I would say that you should NOT ever shoot below a 70ish number. Usually people work gradually down to shooting in the 50's (70's for AT), although you are already there! An experienced person will likely shoot everything over 50ish. You'll see as you shoot normal numbers that the cycle will flatten out to more of a line than a curve. That's Lantus at its best.

The other good bit of info that you might want to read, is on the Tight Regulation Protocol page, about 5 paragraphs down, a PDF you have to download called "Management of a Diabetic Cat Using Long-Lasting Insulin." Not sure if i already gave you that. But it's worth downloading and trying to muddle through - lots of good info there and most of it is in AT numbers.

Kudos on getting Samantha started! She's not too high, so perhaps it won't take her long to become controlled. Here are the TR guidelines that apply to her at this time:

REQUISITES WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:

Kitty should be monitored closely the first three days when starting Lantus or Levemir.
Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
More monitoring may be needed.
It will be necessary to test kitty's blood glucose levels multiple times per day.
Learn the signs of and how to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.
Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).
Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
Feed a high quality low carb canned or raw food diet.
Feed small meals throughout the day. Some kitties adapt well to free feeding.


Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.
(Revised 10/28/2013)

"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Click to expand...

Re: Jack - AMPS 155 Gave .5 - Dosaage vs. Numbers questions

Ok, Wow, System Overload.

Julie, Wendy, Sienne and Suzanne,

Thank you for the responses they are all appreciated. I am here to learn and help my kitties. I have to take the ? mark off now. I have enough to process. Ooops, scratch that. I was able to process some of the info and have some more questions.

I use AlphaTrak because it was what the Vet recommended. Right wrong or indifferent this is what I am using. Expensive? Eh, Maybe in comparison to the Human ones..but hey, when it comes to my Kitties, I will go without before they EVER will.

I will not follow the one that I referenced. I will use the one everyone here uses..No question..

In regards to meters, the protocol we are going to follow does say:

In general, with the availability of accurate and precise glucometers calibrated for
feline blood, their use is recommended in preference to meters calibrated for human
blood because of the greater accuracy for blood glucose measurements around the
normoglycemic range. Using meters calibrated for feline blood facilitates the use of
target blood glucose concentrations in the normal range reported for cats and avoids
some of the confusion with human meters whether they are reading whole blood or
plasma.

Click to expand...

That is in "general" and to each their own. What we have is what we use until such time as we are not comfortable with it or we learn there are better options and are willing to make a change. Since I am new and have experience with the AT, that is what I am going to stick with. I will ensure that I mention the AT often as I am "non-standard".

Well, so lets start somewhere with Jack.

Tonight his PMPS was 107. I was like, great. Did I call it or what ?...But I was bound to get there sooner or later..Sooner is better for Jack so Daddy is just going to have to follow Jack's lead for this dance.

I gave him the .5 and am prepared for a + 2 in 8 minutes . I will also do a +3,4 and 5. I expect I am going to be in the lower 70's. Only time will tell. I have my hypo kit ready. On the 2 occasions that he was way low, he presented no signs and licked off my finger fine. I forgot the Gravy FF today at the market, damn. Is the difference between the Karo and the Gravy high carb is that the gravy will stay in his system longer?

So if I get low 70's then it might be time for an adjustment? I am not sure I would be so comfortable again with shooting .5u on a 100 PS.I work from home so testing is not really an issue although with 2 kitties to tend to, I have to ensure that I do not get overloaded.

Update: Jack's +2 was 93. I have not done hardly any +2's so not sure what it means. It is going lower but the food should also be starting to kick in as well as the insulin. It is leveling things out. Is that surfing?

Also, I started today spreading the meal out. The same quantity just portioned. I did not get any feedback on what the optimum times for that would be. Any thoughts? I do know that no food for 2 hours before PS. Right?

This morning I Shot at 6 AM fed and fed the other probably 1/3 at 10 am. Tonight I just gave Jack his other 1/3 when I tested his +2. Trying to ease the load on the pancreas.

Would it make sense to give the other portion at maybe +4 or +6 after nadir? I just do not know. The +4 or +5 is when I usually take for his nadir and was wondering what the portioning would do to the +4 or +5. Lower portion before the +4 would likely produce lower numbers because there is not as much sugar (food) in him..Correct? I guess some of this is a wait and see but any input would be greatly appreciated.

That is about all for right now. Will update on the hour.

Thanks again.

Re: Jack - AMPS 155 Gave .5 - Dosaage vs. Numbers questions

+3 81.

I did give him the rest of tonight's portion @ +2. Hope the digestion of food and insulin balance. Am getting a little nervous.

Re: Jack - AMPS 155 Gave .5 - Dosaage vs. Numbers questions

you're doing fine!

we compare the +2 to the preshot number to get a somewhat accurate idea that works in most cats, on where the rest of the cycle might be pointing. With a preshot of 107 and a +2 of 93, we can see it's a very active cycle. Typically Lantus onsets (starts its action) about 2 hrs after the shot, so the +2 is typically about the same number as the preshot.

You're doing fine though - you don't have to do anything until he goes below 68. Then you can give him a drop or two of karo and repost here.




Regarding the feeding question - most cats do well with most of the food in the first few hours after the shot. That makes the carbs from the food be present when the insulin is strongest. If you feed too much in the second 6 hours of each cycle, when Lantus is waning, it can result in a higher preshot. If the cat is a grazer, that might not be a problem. Some cats are delicate eaters and just nibble around the clock. Those cats might be able to have food out most of the time. If a cat is a hoover, ie, will eat everything you put down the second you put it down, you probably want to keep all the food in those first few hours of each cycle. I fed punkin at preshot (3oz) and +3 (1.5oz) and besides that, he got boiled chicken bits as pokey treats.

Re: Jack - AMPS 155 Gave .5 - Dosaage vs. Numbers questions

oh - and that quote about the AT is interesting. That doc was from Dr. Rand, and is an updated of the Rand/Roomp Tight Regulation Protocol that we use. It's curious that she said that about using the AT, because in the original study there was a lot of support for using human meters. The original TR document has all numbers in human meters. We've talked about this change - I'm not sure what the reasoning is for her switch, but people almost all use human meters because of the cost. Following Tight Regulation means that sometimes you're doing a ton of testing in each day. Routinely most people do at least 5 tests a day. My biggest day was 20+ tests when dealing with low numbers. When you're paying $1 per strip for months/years, it can make a huge difference. My punkin had acromegaly, a benign tumor on the pituitary gland that causes lots of problems, including a need for large doses. He got up to 15.5u per shot before we had him treated at Colorado State with radiation therapy. It was a hugely expensive 2.5 years that he was diabetic before he died (not from diabetes.)

There are a couple of other people who use ATs also. It's totally fine - it just means that you've got to do some math to have a good idea of where Jack & Samantha's blood sugar compares to other cats on here. When the protocol is talking about normal numbers being 50-120, you want to think 68 - 160ish. The difference between the meters is smaller at the low end and as much as 30-40% in the highest numbers.

The color coding on your spreadsheet is also set for human meters. Might be easiest for you to kind of ignore the colors. The most important number for you is going to be 68.

You can probably see that people post using a convention, by updating their first post in a thread and updating that subject line. That's the only one that shows on the main page, so everyone updates that one.

People scan the main page subject lines to keep an update on cats. So right now, Jack's would say

9/11 Jack pmps 107, +2/93, +3/81 AT

That puts his situation in context and people will pop in to help you if you need it. If you get scared, you can also put "HELP" in the subject line. That'll bring everyone.

Re: 9/11 Jack pmps 107, +2/93, +3/81 +4/81 AT

Hi Julie,

Thank you so so much for everything. Including being here. For that, well words just don't quite cut it.

How does the 2nd 81 look ? I am used to a +4 and +5 together. Of course with my limited 3's I am not exactly in familiar territory.

Now I understand about the food. Makes sense when you have all the information and can process it.

2 days ago I ordered another 100 strips and Lancets for AlphaTrak, yeah $125. Now with Samantha, I had to. With tonight and Jack and who knows what tomorrow morning will bring. Not sure they will arrive in time. I may just go to Walmart and get one of those reliOn meters. Just looking now, wow they are inexpensive. Question, the Confirm or the Prime?

Not a bad idea to have an emergency backup anyway and now I am more aware of the differences and looking at the info BJM put together, I think I can handle the conversions.

42 minutes till +5. I am thinking lower, hoping by just a little..although I didn't start out that high tonight...
Kevin

Re: 9/11 Jack pmps 107, +2/93, +3/81 +4/81 AT

Hi Julie,

Oh and thanks for the tips on the posts.

I am not nor have ever been a "Boards" person. Any tips and tricks are greatly appreciated.

Still trying to see how I can just view my posts and would like if I posted in someone else's I could kinda track that.

Way not important now, I got the subject which is most important. I do not want to say I need help unless I really really do.

Thanks

Re: 9/11 Jack pmps 107, +2/93, +3/81 +4/81 AT

actually, this is perfect! you want him to stay in that 68-160 range for as many hours as possible. When a cat's body is in that range, the pancreas can heal. that's the path to going OTJ (off the juice, or diet-controlled.)

I do know how much it means to have someone there, explaining as you encounter things. others did it for me too. this is the best site ever - people help in whatever way they can. everyone is a volunteer layperson, but we understand FD and insulin because we have so much experience with it.

I'll watch for your +5. You're doing great, kevin. Keep it up!

oh - about the confirm/prime - i had a confirm and it was fine. the prime wasn't out when i bought the confirm. i bought generic strips that worked in the confirm from American Diabetes Wholesale. I registered first at http://www.mrrebates.com to get rebates from buying at ADW. if you want opinions, though, there are people who know pros/cons of prime/confirm. just edit your subject line (first post only) and ask for opinions. you'll get plenty. :lol:

Re: 9/11 Jack pmps 107, +2/93, +3/81 +4/81 AT

don't worry about asking for help. everyone's received help starting out and people are more than willing to step in to help you, and if you ask for opinions OY VEY, you'll have plenty! :lol:

There is a ? in the row of post icons which is located above the subject line. When you have a ? it's helpful if you use that ? icon, then edit andremove it when you have answers that satisfy you. People get on the board frequently throughout the day and scan for the question mark first, or look for comments/questions in the subject lines.

the convention i mentioned (and you used) for the subject line is a great help. sometimes when you're new you don't even know what questions to ask. experienced people can catch things that are important in the numbers sometimes.

Re: 9/11 Jack pmps 107, +2/93, +3/81 +4/81 AT

The Confirm requires a smaller blood drop, 0.3 which I think is the same size as the Alphatrak. Best price for strips is ADW as Julie listed and the best price for the generic ones on that site is the buy 4 get one free deal.

The Prime requires a larger blood drop, 0.6, but the strips are cheaper, although they are only available from Walmart.

Re: 9/11 Jack pmps 107, +2/93, +3/81 +4/81 +5/74

Hi Julie and Wendy,

Thanks for the info on the ReliOn. Looks like Confirm it is. Now the tough decision....Blue or Pink...Geezzz...I got a girl and a boy. Maybe pink and we will tell Samantha we purchased it just for her!. Yeah that's it.

ok so +5 @ 74. still hanging 10.....

I will do a +6 and what hope to see it go up slightly ? I know ECID but from what I read that should kinda be the trend. right?

If it goes further down..to lets say 70, I bet you might say to test it @ +7 ? or maybe sooner just to ensure it is not really heading down significantly? Below 70 and the Karo comes out. Surf waves or not..Time to come to shore.

Am I getting it?

Thanks for the kudo's. I know I can do it thanks for FDMB and people like you.

Shelly was my first contact and she was just super. She referred me to TR because I was getting into the dosage arena. So glad she made that recommendation even though at first look, TR looks like a place you just don't mess around in. It maybe (such an understatement) more work, but in the end it is all worth it I know it.

Kevin

Re: 9/11 Jack pmps 107, +2/93, +3/81 +4/81 +5/74

it's not as complicated as it looks at first glance. i lurked for a couple of months before i joined. the language put me off "surfing the greens" or "green lagoon" type of comments. Now i know that it was all in reference to the colors of the spreadsheet. Joining here was the best thing I could've done for punkin. IT's all about what's good for the cat!

People help new members learn and everyone is patient, so don't worry about asking too many questions or not knowing something. Shelly is great, isn't she?!

On a flat cycle like this (which I'll just say is a perfect cycle!) he may coast along like this for the entire 12 hours. At this point, I'd keep testing. Getting to 74, I'd test in 30 minutes after that last +5/74. If he goes below 68, we want to know so you can reduce his dose on the next shot.

you have the basic idea, yes!

Re: 9/11 Jack pmps 107, +2/93, +3/81 +4/81 +5/74

It's always good to have a back up meter. I have a pink AND a blue one. :lol:

Easy does it Jack - looking good. :mrgreen:

Re: 9/11 Jack pmps 107, +2/93, +3/81 +4/81 +5/74 +5.5/79

Hi Julie,

I did as you suggested at +5.5 I got 79. So it did go up a bit. Kind of expected..The insulin is waning..Right? ...his numbers should now just trend up. To what the AMPS will be..I got no clue..But I am sensing, it is going to cause more questions.


Do you think 1 more at +6 would be ok so long as it is not lower than the 79?

Going to need some sleep, but if this next test goes well, I will feel good and hope that will lead to some rest. I will need it tomorrow no matter, with 2 to test and shoot.

Will await your reply.

Re: 9/11 Jack pmps 107, +2/93, +3/81 +4/81 +5/74

If you need to go to bed, leave plenty of low carb food out. He's basically flat. It's your call. You're getting a bit of baptism by fire. Nothing like surfing low you first day or two into TR. :shock:

If he were mine, i'd probably want one more test at +6 and if it's about the same i'd leave food out. I'd like wendy's opinion too.

Re: 9/11 Jack pmps 107, +2/93, +3/81 +4/81 +5/74

Hey JUlie,

+6/76.

I gave him some (12) DM chows. I think that this should be good. I really cannot leave any kind of food out as Samantha is a hoover.

I have to get some sleep to be ready for the morning.

I think tonight was a big success thanks to your help.

Re: 9/11 Jack pmps 107, +2/93, +3/81 +4/81 +5/74 +5.5 79 +6

Often people will nap with a light on and cell alarm set. I would feel better if you could check a gain.

By the way, this is the path to otj.

I'm west coast and will check on you again in an hour. At any point if you need help for low numbers under 68, hit the 911 in the first subject line

Well done today.

Re: 9/11 Jack pmps 107, +2/93, +3/81 +4/81 +5/74 +5.5 79 +6

It looks like Jack is surfing on the edge. :shock: We normally recommend getting two rising numbers, without influence of food, before calling it a night. When did he last get food - before the dry food?

Re: 9/11 Jack pmps 107, +2/93, +3/81 +4/81 +5/74 +5.5 79 +6

Kevin haasn't given him any hc at this point.

Re: 9/11 Jack pmps 107, +2/93, +3/81 +4/81 +5/74 +5.5 79 +6

Good Morning Julie and Wendy,

I had to get some sleep, as it was 5 AM came all too early.

I have a kitchen timer I set next to the bed whenever I have to get up. Last night I was up through it all till midnight.

I gave him some DM chows and checked him until 1:30 AM. It shows this morning with an AMPS of 141.

Got to get some other flavored FD treats. Shrimp he hates.

Ah well, a new day. and I will post a new thread. @ 141 he still gets the .5. If tonight is another 107 then I am going to spill off a couple drops.

Going test how many drops are in .5. Then I will know how many drops to lose to take the dose down a notch.

Thanks for all the help and support.